Efficacy And Safety Of Insulin Pump And Multiple Subcutaneous Insulin Injection In The Treatment Of Early Diabetic Nephropathy: Systematic Evaluation And Meta-analysis

ObjectiveMeta analysis was used to explore whether there are differences in efficacy and safety between insulin pump and multiple subcutaneous insulin injection in patients with early diabetic nephropathy.MethodsThe English database(Pub Med,Webof Science,Embase)and the Chinese database(China knowledge Network,Wanfang,Vip,Chinese Biomedical Literature)were searched by computer.The time span from the establishment of the database to January 2023 was used to search and screen all the published randomized controlled trials of patients with early diabetic nephropathy who were treated with insulin pump or multiple subcutaneous insulin injection.The quality of the included literature was evaluated(Cochrane system literature quality evaluation method),data extraction and meta-analysis(stata15.0 software).Results1.23 related articles were included in this study.2.The results of Meta analysis showed that :the curative effect index:UAER[SMD(95%CI)=-2.05(-2.56～-1.54),P=0.000]、24h Upr V [SMD(95%CI)=-0.77(-1.36～-0.19),P=0.000] 、 β-MG [SMD(95%CI)=-0.68(-0.82～-0.55),P=0.034]、Glomerular filtration rate [SMD(95%CI)=-0.42(-0.80～-0.03),P=0.000]、Hb A1 C [WMD(95%CI)=-0.42(-0.80～-0.03),P=0.000] 、 FPG [WMD(95%CI)=-1.14(-1.20～-1.07),P=0.018]、2h PG [WMD(95%CI)=-1.35(-1.64～-1.05),P=0.000],The difference of the above curative effect indexes between the two groups was statistically significant.There was only one article on other indexes HCY,Crp and Cysc,and the improvement was more obvious in the insulin pump group.Generally speaking,it can be considered that the use of insulin pump has more advantages in improving the curative effect in patients with early diabetic nephropathy.Adverse event: hypoglycemia[OR(95%CI)=0.21(0.11～0.41),P=0.970] 、 Blurred Vision[OR(95%CI)=0.35(0.17～0.75),P=0.994],There was a statistical difference in the occurrence of the two adverse events between the two groups.One patient in the insulin pump group withdrew from the experiment because of skin allergy.Two articles related to DKA events.Although neither of the two articles compared the possibility of DKA events between the two groups,there were patients in the insulin pump group who died of DKA.Therefore,it can be considered that the possibility of adverse events in patients with early diabetic nephropathy using insulin pump is less,but malignant adverse events may occur in insulin pump group.3.The sensitivity analysis of this article suggests that the results of Meta analysis of other indicators and adverse events except Ccr are stable,so it is considered that the results of Meta analysis are stable.In the publication bias analysis,only the Egger’stest value of hypoglycemia was P < 0.05.Therefore,it was considered that there was little possibility of publication bias in this Meta analysis.ConclusionIn terms of efficacy,insulin pump can better improve renal damage and blood glucose in patients with early diabetic nephropathy than multiple subcutaneous insulin injections.In terms of safety,the probability of adverse events in insulin pump is lower than that in multiple subcutaneous insulin injections,but malignant adverse events may occur in insulin pump group.